Planned Community Change Project

By: James Furstenau, Sandie Martini, Ashleigh Wash, and Stephanie Yohn

Problem Statement

Poverty level children in Kent County, MI are at greater risk for poorer health outcomes related to the inability to access healthcare

resources as evidenced by lack of health insurance.

Poverty Level Defined

According to the National Center for Children in Poverty (2012), 22% of children in the United States live below the federal poverty level:▫$18,000 for a single-parent family of three

▫$23,000 for a two-parent family of four.

According to the U.S. Census Bureau (2013), in the year 2011,

•9.7% of all children under 19 (7.6 million) were without health insurance in the nation.

•The uninsured rate for children in poverty is 13.8% which is higher than the rate for all children nationally.

Concepts that may determine why this is happening…

•Concept of Ignorance

•Concept of Economic Inequality

Kent County StatisticsIn Kent County, the child poverty rate grew from16.3 percent in 2005-06 to 23.1 percent in 2010-11(McVicar, 2013)

Kent County is the 4th highest ranked in Michiganfor the number of uninsured children under the ageof 18. (US Census Bureau, 2007).

Top 5 counties ranked of uninsured children:1. Wayne County (31,838)2. Oakland County (19,387)3. Macomb County (13,445)4. Kent County (12,826)5. Genesee County (7,298)

Barriers for Kent CountyRural areas in Michigan such as Kent County, have been hit the hardest with the worsening economy.  Child poverty is increasing and spending is limited with safety net programs that could address these problems. (Martin, 2013)

Michigan is currently going through a Great Recession:

▫ The economy is slowing down▫ Houses are worth less▫ Less employment opportunities available▫ People are earning less money and work fewer hours▫ The poverty rate is increasing

This presents a challenge when the economy is poor and insurance premiums are becoming more expensive. The government has also cut spending on federally funded health care (Hoogterp, 2011).

Strengths for Kent County

• Multiple programs through the Department of Human Services are out there for low income children. (i.e. Healthy Kids, MI Child, Under 21, and Children’s Special Health Care Services)

• The Affordable Care Act▫ Medicaid coverage▫ Free preventative care

• Children’s Health Care Access Program (CHAP)

Why is insurance so important?

• COST- you pay for everything when you are uninsured.

• Problems accessing health care.

• Mortality rate is higher.

• No insurance can be the cause of exacerbation of health problems.

(Cocke, 2010)

What health programs does Kent County already have in place for children?The good...the bad...and the ugly...

Program Description Good Points Bad Points

Healthy Kids Medicaid health program for low income children under the age of 19.  

• No monthly premium

• Provides benefits such as dental, vision, and mental health services

• Income based (strict)

• Must be US citizen with a SS number and live in Michigan even for a short period of time.

Under 21 Medicaid based program for people under the age of 21.

• Includes vision, dental, and mental health services.

• Income and asset based.  

• Premium is determined by income level.

Program Description Good Points Bad Points

MIChild Department of Community Health program for low income uninsured children under 19.

• Income eligibility limit is higher than the others.

• Does not include dental.

• Premium is determined by income level.

Children’s Special Health Care Services

Department of Community Health program for children under 21.

• Can be used as a secondary insurance.

• Covers all things related to child’s medical condition.

• Has to have a qualifying medical condition.

• Eligibility is determined by the severity of the condition.

• Only pays for treatment related to the condition and not other things such as well visits.

What is the problem?

Increased Participation• "The number of Kent County children

enrolled in Medicaid increases every year–it’s now about 40%.” (Children's Healthcare Access Programs, 2012).

• Higher premiums and co-payments may prevent some employees from enrolling or seeking needed health care services. (Cutler, 2002).

Accessibility

• There is only one Department of Human Services for approximately 609,000 residents (U.S. Census Bureau).

• Limited hours (open M-F 7am-4pm).

• Application assistance by appointment only. Online applications are only in English with limited calling hours for alternative language assistance (www.michigan.gov/dhs).

Gaps in Coverage “Despite recent expansions in coverage to low-income populations, some children continue to experience gaps in coverage that are shown, in this analysis, to be related in the expected direction to both poor health and positive assessments of health”.

(Slack, Holl and Yoo, 2007)

Research indicates that children on public assistance (Medicaid) have poorer health outcomes.

A study, led by Dr. Tom Peterson and published in the Journal of Pediatrics in January 2011, found that children with Medicaid have poorer health outcomes as evidenced by:• Significantly higher hospitalization rate• More severe illnesses resulting in hospitalization• Significantly higher rate of respiratory illnesses, such

as asthma• More visits to the emergency room• Higher readmission rates for newborns after discharge

from the hospital (Peterson, Peterson, Armon and Todd, 2011)

Lower Income = Poorer Health

“Children in low-income families are more likely to be reported by their caregivers as having poor health and have been shown to have higher rates of mortality, disability, and co-occurring health conditions than children from higher-income families.”

~(Slack et al., 2007)

Health Belief Model

retrieved from www.medicine.uottawa.ca

Specifies that community health-related behavior depends on:1. The severity of potential illness2. The level of conceivable susceptibility3. The benefits of taking preventative action4. What stands in the way

(Harkness & DeMarco, 2012)

Interventions

Education

• Provide information pamphlets and application kits at booths in craft shows and fairs.

• Hold rotating monthly meetings at Community Centers.

• Work with Case Managers and Social Services to provide education and applications for parents regarding available programs.

• Public Health Nurses to assess patient resources on initial visit after baby is born in the home, and also provide further education or assistance and referrals.

• Collaborate with Local News stations for a weekly health spot on the evening news.

Promotion

Initiate preventative care measures that focus on children’s health with existing programs such as:•Diet plans through promoting use of “Veggie

Van”. (www.grymca.org/outreach/veggie-van)

•Exercise plans through FIT initiative concept. (www.mlive.com/news/grandrapids/index.ssf/2011/03/grand_rapids_fit_initiative_ha.html)

• Healthy living initiatives through Action for Healthy Kids. (www.take.actionsforhealthykids.org/site/Clubs?club_id=1150&pg=main)

Awareness

Inform the community about all of the programs available by:

• Placing poster boards in prominent places like parks, restaurants, and grocery stores.

• Utilize social media: Facebook ,Twitter and Pintrest to link to a website designed to educate on services available in the area.

• Create radio ads highlighting services and how to contact the agencies toll free.

Indicators of Success

Quantitative data will be taken every five years from the U.S. Census determining how many

children lack health insurance.

ReferencesAccessKent. (2012). Medicaid enrollment and coordination. Retrieved from:

http://www.accesskent.com/Health/HealthDepartment/Preg_Parent_Svcs/medicaid_enroll.htm

Children's Healthcare Access Program (2012). Retrieved from:

http://www.firststepskent.org/programs/childrens-healthcare-access-program/

Cocke, A. (2010). What are the dangers of being uninsured? Livestrong.com. Retrieved from:

http://www.livestrong.com/article/135433-what-are-dangers-being-uninsured/

Cutler, D. (2002). Employee costs and the decline in health insurance coverage. National Bureau of

Economic Research Working Paper Series, No. 9036., National Bureau of Economic Research,

Cambridge, MA

Department of Human Services (2013). Retrieved from: http://www.michigan.gov/dhs/

Harkness, G.A., DeMarco, R.F. (2012). Community and public health nursing evidence for practice.

Philadelphia, PA: Lippincott, Williams & Wilkins

Hoogterp, E. (2011). Great recession leaves Michigan poorer, census numbers show. MLive. Retrieved

from:

http://www.mlive.com/news/index.ssf/2011/10/great_recession_leaves_michiga.html

ReferencesMartin, T. (2013). Michigan kids count report: rural areas also face child poverty and well being issues.

MLive. Retrieved from: http://www.mlive.com/news/index.ssf/2013/01/michigan_kids_count_report.html

McVicar, B. (2013). Child poverty spiked in kent county as great recession took its toll on michigan's

economy. MLive. Retrieved from:

http://www.mlive.com/news/grand-rapids/index.ssf/2013/01/child_poverty_rates_spiked_in.html

Michigan.gov. (2011). Adults and children in poverty. Critical Health Indicators. Retrieved from:

http://www.michigan.gov/documents/mdch/Poverty_380428_7.pdf

Michigan.gov MIChild. Retrieved from: http://www.michigan.gov/mdch/0,4612,7-132-

2943_4845_4931---,00.html

National Center for Children in Poverty. (2012). Child poverty. National Center for Children in Poverty.

Retrieved from: http://www.nccp.org/topics/childpoverty.html

Peterson, T.H., Peterson, H., Armon, C., & Todd, J. (2011). Insurance-associated disparities in hospitalization

outcomes of michigan children. The Journal of Pediatrics, 158(2), 313-318. Retrieved from:

http://www.firststepskent.org/wp-content/uploads/2008/07/CHAP-Research-Article-Jan.-20111.pdf

ReferencesScott, M. (2001). Grand rapids fit initiative has students, parents embracing healthy living. Mlive. Retrieved

from http://www.mlive.com/news/grand-rapids/index.ssf/2011/03/grand_rapids_fit_initiative_ha.html

Slack, K., Holl, J. L., Yoo, J. (2007). Welfare, work, and health care access predictors of low-income children's

physical health outcomes. Children & Youth Services Review, 29(6), 782-801.

U.S. Census Bureau. (2007). Uninsured kids under 19 years in michigan. Enroll Michigan. Retrieved from:

http://new.mha.org/mha/enrollmichigan/docs/uninsuredkidsbycounty.pdf

U.S. Census Bureau. (2013). Income, poverty, and health insurance coverage in the united states: 2011.

U.S. Department of Commerce. Retrieved from:

http://www.census.gov/newsroom/releases/archives/income_wealth/cb12-172.html

U.S. Department of Health and Human Services. (2013). Health care for children. Michigan.gov. Retrieved

from: http://www.michigan.gov/dhs/0,4562,7-124-5453_5530_61806---,00.html

U.S. Department of Health and Human Services. (2013). Take health into your own hands. HealthCare.gov.

Retrieved from: http://www.healthcare.gov/index.html